Differential contributions of prefrontal and temporolimbic pathology to mechanisms of psychosis
Differential contributions of prefrontal and temporolimbic pathology to mechanisms of psychosis
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DOI：
10.1093/brain/awh554
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发表时间：
2005-09-01
期刊：
影响因子：
14.5
通讯作者：
Kurachi, M
中科院分区：
文献类型：
--
作者：
Suzuki, M;Zhou, SY;Kurachi, M
精神分裂症谱系中常见的异常可能是精神分裂症发病的关键，但可能需要额外的病理变化才能发展成全面的精神分裂症。澄清已确立的精神分裂症和较轻微形式的精神分裂症谱系障碍之间的神经生物学异同，可能会将精神分裂症谱系核心特征潜在的病理生理机制与那些与显性精神病有关的机制区分开来。高分辨率磁共振成像来自25名分裂型障碍患者、53名精神分裂症患者和59名年龄、性别、利手和父母教育相匹配的健康志愿者。使用连续1 mm厚的冠状切片对内侧颞叶结构和前额叶皮质亚成分进行体积测量。根据额沟/回的固有解剖标志，将前额叶皮质分为多个亚组分。与对照组相比，分裂型和精神分裂症患者的双侧杏仁核和海马体体积缩小。不同诊断组间的海马区旁回体积无显著差异。精神分裂症患者双侧前额叶灰质体积小于对照组和分裂型患者，而分裂型患者右脑前额叶灰质体积大于对照组。精神分裂症组双侧额上回、左侧额中回、双侧额下回和双侧直回灰质体积均小于对照组。与分裂型患者相比，精神分裂症患者右侧额上回、双侧额中回和右侧额下回灰质体积也减小。与对照组相比，分裂型患者双侧额中回体积较大，右侧直回体积较小。两组间腹侧前额叶皮质或眶前叶皮质的体积无显著差异。这些发现表明，杏仁核和海马体体积的减少是精神分裂症谱系的常见形态底物，这可能代表了脆弱性。另外，精神分裂症患者前额叶皮质的广泛参与可能会导致其他大脑区域失去抑制控制，这表明(尽管这并不是特别相关的)它在显性精神病表现中的关键作用。
Common abnormalities within the schizophrenia spectrum may be essential for the pathogenesis of schizophrenia, but additional pathological changes may be required for the development of full-blown schizophrenia. Clarifying the neurobiological similarities and differences between established schizophrenia and a milder form of schizophrenia spectrum disorder would potentially discriminate the pathophysiological mechanisms underlying the core features of the schizophrenia spectrum from those associated with overt psychosis. High-resolution MRIs were acquired from 25 patients with schizotypal disorder, 53 patients with schizophrenia and 59 healthy volunteers matched for age, gender, handedness and parental education. Volumetric measurements of the medial temporal structures and the prefrontal cortex subcomponents were performed using consecutive 1-mm thick coronal slices. Parcellation of the prefrontal cortex into subcomponents was performed according to the intrinsic anatomical landmarks of the frontal sulci/gyri. Compared with the controls, the bilateral volumes of the amygdala and the hippocampus were reduced comparably in the schizotypal and schizophrenia patients. The parahippocampal gyrus volume did not differ significantly between diagnostic groups. Total prefrontal grey matter volumes were smaller bilaterally in the schizophrenia patients than in the controls and the schizotypal patients, whereas the schizotypal patients had larger prefrontal grey matter than the controls in the right hemisphere. In the schizophrenia patients, grey matter volumes of the bilateral superior frontal gyrus, left middle frontal gyrus, bilateral inferior frontal gyrus and bilateral straight gyrus were smaller than those in the controls. The schizophrenia patients also had reduced grey matter volumes in the right superior frontal gyrus, bilateral middle frontal gyrus and right inferior frontal gyrus relative to the schizotypal patients. Compared with the controls, the schizotypal patients had larger volumes of the bilateral middle frontal gyrus and smaller volumes of the right straight gyrus. There were no significant between-group differences in volumes of the ventral medial prefrontal cortex or the orbitofrontal cortex. These findings suggest that volume reductions in the amygdala and hippocampus are the common morphological substrates for the schizophrenia spectrum, which presumably represent the vulnerability. Additional widespread involvement of the prefrontal cortex in schizophrenia may lead to the loss of inhibitory control in other brain regions and suggests (although it is not specifically be related to) its critical role in the manifestation of overt psychosis.